Clip applier with clip cartridge interface

ABSTRACT

A clip applier includes an end effector that is adapted to releasably engage a clip cartridge. The end effector includes spring arms that are deflectable outwardly to receive and retain the clip cartridge within the end effector. The clip applier includes an outer tube that is movable from an advanced position encompassing the end effector to prevent separation of the clip cartridge from the end effector, to a retracted position spaced proximally of the spring arms. In the retracted position, the spring arms can deflect outwardly from the clip cartridge to disengage the clip cartridge from the end effector.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Patent Application Ser. No. 62/958,435, filed on Jan. 8,2020, the entire content of which is incorporated herein by reference.

FIELD

This technology is generally related to surgical clip appliers and, moreparticularly, to surgical clip appliers with structure for releasablyengaging a clip cartridge.

BACKGROUND

Surgical clip appliers are used to apply ligation clips to body vesselsduring surgical procedures to occlude or partially occlude the bodyvessels. Typically, a surgical clip applier includes a handle assemblyincluding a trigger, an elongate body that extends distally from thehandle assembly, and a tool assembly supported on the elongate body at alocation spaced from the handle assembly. The tool assembly includesjaws that are movable in relation to each other from an open position toreceive a ligation clip and subsequently to a clamped position tocompress the ligation clip about the body vessel.

Surgical clip appliers include single fire clip appliers and multi-fireclip appliers. Single fire clip appliers use the tool assembly towithdraw a single clip from a clip package to load a single clip intothe jaws of the clip applier prior to applying the clip to tissue.Multi-fire clip appliers include a clip cartridge that is coupled to theelongate body of the clip applier. The clip cartridge includes aplurality of ligation clips that are sequentially supplied to the jawsof the clip applier to facilitate placement of multiple clips on a bodyvessel or on body vessels without withdrawing the clip applier fromwithin a body cavity.

Some multi-fire clip appliers include a clip cartridge that can beremoved from the elongate body of the clip applier after use andreplaced with a new clip cartridge. These clip appliers are generallycomplex and expensive to manufacture.

SUMMARY

In aspects, this disclosure generally relates to a clip applierincluding an end effector that is adapted to releasably engage a clipcartridge. The end effector includes spring arms that are deflectableoutwardly to receive the clip cartridge. The spring arms each include aninwardly directed protrusion that is received within a respective recessformed in the clip cartridge to secure the clip cartridge to the endeffector. The clip applier includes an outer tube that is movable froman advanced position encompassing the end effector to prevent separationof the clip cartridge from the end effector to a retracted positionspaced proximally of the spring arms. In the retracted position, thespring arms can deflect outwardly from the clip cartridge to disengagethe clip cartridge from the end effector.

One aspect of the disclosure is directed to a clip applier including ahandle assembly, an elongate body, and an end effector. The handleassembly includes a handle body and a movable handle. The handle bodydefines a stationary handle and a cavity. The elongate body includes anouter tube, an inner shaft, and an actuator rod. The inner shaftincludes a proximal end portion and a distal end portion and defines achannel that extends from the handle assembly through the outer tube.The proximal end portion of the inner shaft is secured to the handlebody. The actuator rod includes a proximal end portion and a distal endportion and extends from within the cavity of the handle body throughthe channel. The actuator rod is movable from a retracted position to anadvanced position in response to actuation of the movable handle. Theouter tube includes a distal end portion and a proximal end portion andis positioned about the inner shaft for movement from a retractedposition to an advanced position. The end effector is fixedly supportedon the distal end portion of the inner shaft within the outer tube andincludes spaced flexible arms that have an inwardly extendingprotrusion. In its advanced position, the outer tube is positioned aboutthe spaced flexible arms of the end effector to prevent outwarddeflection of the flexible arms of the end effector and, in itsretracted position, the outer tube is moved to a position to allowoutward deflection of the spaced flexible arms of the end effector.

Other aspects of the disclosure are directed to a clip applier includinga handle assembly, an elongate body, and an end effector. The handleassembly includes a handle body and a movable handle. The handle bodydefines a stationary handle and a cavity. The elongate body includes anouter tube and an inner shaft. The inner shaft includes a proximal endportion and a distal end portion and defines a channel that extends fromthe handle assembly through the outer tube. The proximal end portion ofthe inner shaft is secured to the handle body. The outer tube includes adistal end portion and a proximal end portion and is positioned aboutthe inner shaft for movement from a retracted position to an advancedposition. The end effector is fixedly supported on the distal endportion of the inner shaft within the outer tube. The end effectorincludes spaced flexible arms that each has an inwardly extendingprotrusion. In its advanced position, the outer tube is positioned aboutthe spaced flexible arms of the end effector to prevent outwarddeflection of the flexible arms of the end effector and, in itsretracted position, the outer tube is moved to a position to allowoutward deflection of the spaced flexible arms of the end effector.

Further aspects of the disclosure are directed to a clip applierincluding a handle assembly, an elongate body, an end effector, a firstbiasing member, and a second biasing member. The handle assemblyincludes a handle body and a movable handle. The handle body defines astationary handle and a cavity. The elongate body includes an outertube, an inner shaft, and an actuator rod. The inner shaft includes aproximal end portion and a distal end portion and defines a channel thatextends from the handle assembly through the outer tube. The proximalend portion of the inner shaft is secured to the handle body. Theactuator rod includes a proximal end portion and a distal end portionand extends from within the cavity of the handle body through thechannel. The actuator rod is movable from a retracted position to anadvanced position in response to actuation of the movable handle. Theouter tube includes a distal end portion and a proximal end portion andis positioned about the inner shaft for movement from a retractedposition to an advanced position. The end effector is fixedly supportedon the distal end portion of the inner shaft within the outer tube andincludes spaced flexible arms that have an inwardly extendingprotrusion. In its advanced position, the outer tube is positioned aboutthe spaced flexible arms of the end effector to prevent outwarddeflection of the flexible arms of the end effector and, in itsretracted position, the outer tube is moved to a position to allowoutward deflection of the spaced flexible arms of the end effector. Thefirst biasing member is positioned to urge the outer tube towards itsadvanced position and the second biasing member is positioned about theproximal end portion of the actuator rod to urge the actuator rod to itsretracted position.

In aspects of the disclosure, a biasing member is positioned to urge theouter tube towards the advanced position.

In some aspects of the disclosure, a rotation knob is secured to theproximal end portion of the outer tube and is movable from an advancedposition to a retracted position to move the outer tube from itsadvanced position to its retracted position.

In certain aspects of the disclosure, the biasing member includes a coilspring that is received about the proximal end portion of the innershaft of the elongate body within the rotation knob.

In aspects of the disclosure, the end effector includes a body formed ofa polymeric material, and the spaced flexible arms are formed of springsteel and are secured to the body of the end effector.

In some aspects of the disclosure, the body of the end effector ismolded about the spaced flexible arms.

In certain aspects of the disclosure, the end effector includes a bodythat is monolithically formed with the spaced flexible arms of the endeffector.

In aspects of the disclosure, the movable handle includes an engagementmember that is positioned within the cavity of the handle body andmovable between retracted and advanced positions to move the actuatorrod between its advanced and retracted positions.

In some aspects of the disclosure, the engagement member includes anengagement surface and the proximal end portion of the actuator rodincludes an abutment member.

In certain aspects of the disclosure, the engagement surface engages theabutment member such that actuation of the movable handle causesmovement of the actuator rod from its retracted position to its advancedposition.

In aspects of the disclosure, the abutment member is disc-shaped, andthe engagement surface is curved.

In some aspects of the disclosure, the engagement member defines a slotand the abutment member includes an oval ring that is received withinthe slot.

In aspects of the disclosure, the distal end portion of the inner shaftof the elongate body defines a cylindrical cavity and the end effectorincludes a cylindrical body portion that is received within thecylindrical cavity to secure the end effector to the distal end portionof the inner shaft.

In some aspects of the disclosure, a metal bearing is positioned aboutthe proximal body portion of the end effector within the cylindricalcavity of the inner shaft of the elongate body.

In certain aspects of the disclosure, a biasing member is positionedabout the proximal end portion of the actuator rod to urge the actuatorrod towards its retracted position.

Other features of the disclosure will be appreciated from the followingdescription.

BRIEF DESCRIPTION OF DRAWINGS

Various aspects of the disclosure are described herein below withreference to the drawings, wherein:

FIG. 1 is a perspective view of exemplary aspects of the disclosedsurgical clip applier with an outer of the surgical applier in aretracted position;

FIG. 2 is an exploded view of the surgical clip applier shown in FIG. 1;

FIG. 2A is an enlarged view of the indicated area of detail shown inFIG. 2 ;

FIG. 2B is a side perspective view of the end effector of the surgicalclip applier shown in FIG. 2 ;

FIG. 3 is a side perspective, partial cross-sectional view of a proximalportion of the surgical clip applier shown in FIG. 1 with a body portionremoved;

FIG. 4 is a cross-sectional view taken along section line 4-4 of FIG. 1;

FIG. 5 is a cross-sectional view taken along section line 5-5 of FIG. 4with the outer tube and a rotation knob of the surgical clip applier inan advanced position;

FIG. 6 is a side perspective view of the end effector of the surgicalclip applier shown in FIG. 1 with a clip cartridge spaced from the endeffector prior to attachment of the clip cartridge to the end effector;

FIG. 7 is cross-sectional view taken along section line 5-5 of FIG. 4with the outer tube and the rotation knob of the surgical clip applierin a retracted position;

FIG. 8 is a side cross-sectional view of a distal end portion of thesurgical clip applier shown in FIG. 1 as the clip cartridge of FIG. 6 isadvanced towards the surgical clip applier;

FIG. 9 is a side cross-sectional view of the distal end portion of thesurgical clip applier and the clip cartridge shown in FIG. 8 as the clipcartridge engages the end effector of the surgical clip applier;

FIG. 10 is a side cross-sectional view of the distal end portion of thesurgical clip applier and the clip cartridge shown in FIG. 9 with theclip cartridge engaged with the end effector of the surgical clipapplier and the outer tube in its advanced position;

FIG. 11 is a cross-sectional view taken along section line 11-11 of FIG.10 ;

FIG. 12 is a side perspective view of an alternative end effector of thesurgical clip applier shown in FIG. 1 ;

FIG. 13 is a side cross-sectional view of the distal end portion of thesurgical clip applier shown in FIG. 1 and clip cartridge shown in FIG. 6including the end effector shown in FIG. 12 with the outer tube in itsadvanced position;

FIG. 14 is a side perspective view of the proximal portion of thesurgical clip applier shown in FIG. 1 with a body portion removed andincluding alternative aspects of the handle assembly; and

FIG. 15 is a cross-sectional view taken along section line 15-15 of FIG.14 .

DETAILED DESCRIPTION

The disclosed surgical clip applier will now be described in detail withreference to the drawings in which like reference numerals designateidentical or corresponding elements in each of the several views.However, it is to be understood that aspects of the disclosure includedherein are merely exemplary of the disclosure and may be embodied invarious forms. Well-known functions or constructions are not describedin detail to avoid obscuring the disclosure in unnecessary detail.Therefore, specific structural and functional details disclosed hereinare not to be interpreted as limiting, but merely as a basis for theclaims and as a representative basis for teaching one skilled in the artto variously employ the disclosure in virtually any appropriatelydetailed structure. In addition, directional terms such as front, rear,upper, lower, top, bottom, distal, proximal, and similar terms are usedto assist in understanding the description and are not intended to limitthe disclosure.

In this description, the term “proximal” is used generally to refer tothat portion of the device that is closer to a clinician, while the term“distal” is used generally to refer to that portion of the device thatis farther from the clinician. In addition, the term “endoscopic” isused generally to refer to endoscopic, laparoscopic, arthroscopic,and/or any other procedure conducted through a small diameter incisionor cannula. Further, the term “clinician” is used generally to refer tomedical personnel including doctors, nurses, and support personnel.

FIG. 1 illustrates exemplary aspects of the disclosed clip applier showngenerally as clip applier 10. The clip applier 10 includes a handleassembly 12, an elongate body 14, and an end effector 16 that isreceived within a distal end portion 14 a of the elongate body 14. Thehandle assembly 12 includes an actuator handle 18 and a handle body 20defining a stationary handle 22. The handle body 20 includes a distalhub portion 20 a (FIG. 3 ). Although the handle assembly 12 isillustrated to have a pistol configuration, other handle configurationsare envisioned. In the illustrated configuration, the actuator handle 18is coupled to the handle body 20 and can pivot towards the stationaryhandle 22 to actuate the clip applier 10 as described in further detailbelow.

FIG. 2 illustrates an exploded view of the clip applier 10. The handlebody 20 includes a first handle body portion 24 and a second handle bodyportion 26 that are secured together to define the handle body 20. Thefirst and second handle body portions 24, 26, respectively, define acavity 28 that receives a portion of the actuator handle 18. In aspectsof the disclosure, the first and second handle portions 24, 26 aresecured together using any one of a variety of securement techniquesincluding welding, screwing, and gluing. The first handle body portion24 supports a pivot member 30 that is received in a bore 32 of theactuator handle 18 to support the actuator handle 18 for pivotingmovement in relation to the stationary handle 22. The portion of theactuator handle 18 received within the cavity 28 of the handle body 20includes an engagement member 34 that includes a curved engagementsurface 34 a. The engagement member 34 moves between retracted andadvanced positions within the cavity 28 in response to movement of theactuator handle 18 in relation to the stationary handle 22 through anactuation stroke.

The elongate body 14 includes an inner shaft 39 (FIG. 5 ), an actuatorrod 44, and an outer tube 46. The inner shaft 39 has a proximal endportion and a distal end portion and is formed from a first elongatebody portion 40 and a second elongate body portion 42 that are coupledtogether to define an elongate channel 48 that extends from the handleassembly 12 through the elongate body 14 to the end effector 16. Inaspects of the disclosure, the first elongate body portion 40 is formedintegrally with the first handle portion 24 and the second elongate bodyportion 42 is formed integrally with the second handle portion 26.Alternately, the body portions 40, 42 can be formed separately from thehandle portions 24, 26 and secured to the handle assembly 12 using knowntechniques. The first and second elongate body portions 40, 42,respectively, define a cylindrical recess 43 (FIG. 2A) at the distal endportion 14 a (FIG. 1 ) of the elongate body 14.

FIGS. 3-5 illustrate internal components of the handle assembly 12including the engagement member 34 of the actuator handle 18 and theactuator rod 44. The actuator rod 44 includes an elongate shaft 50 and aproximal abutment member 52. In aspects of the disclosure, the proximalabutment member 52 of the actuator rod 44 is disc-shaped and issupported within the cavity 28 of the handle assembly 12. Alternately,the proximal abutment portion 52 of the actuator rod 44 can assume avariety of different configurations. The elongate shaft 50 of theactuator rod 44 has a proximal end portion 54 (FIG. 3 ) and a distal endportion 56. The proximal abutment member 52 is secured to, or formedintegrally with, the proximal end portion 54 of the actuator rod 44. Thedistal end portion 56 of the actuator rod 44 extends through the endeffector 16 (FIG. 4 ). The actuator rod 44 is movable within theelongate channel 48 of the elongate body 14 in response to actuation ofthe actuator handle 18 between a retracted position (FIG. 4 ) in whichthe distal end portion 56 of the actuator rod 44 is positioned withinthe end effector 16 (FIG. 4 ) and an advanced position (not shown) inwhich the distal end portion 56 of the actuator rod 44 extends distallyof the end effector 16 into a clip cartridge 102 (FIG. 6 ).

A biasing member, e.g., a coil spring 60, is received about the proximalend portion 54 of the actuator rod 44 and is positioned to urge theactuator rod 44 towards its retracted position in which the proximalabutment member 52 of the actuator rod 44 is engaged with the engagementsurface 34 a of the engagement member 34 of the actuator handle 18. Inaspects of the disclosure, the coil spring 60 is positioned between theproximal abutment member 52 of the actuator rod 44 and an inner wall 64of the handle body 20 to urge the actuator rod 44 in the proximaldirection. When the actuator handle 18 is pivoted towards the stationaryhandle 22, the engagement member 34 of the actuator handle 18 engagesthe proximal abutment member 52 of the actuator rod 44 to move theactuator rod 44 from its retracted position towards its advancedposition against the bias of the coil spring 60.

The outer tube 46 of the elongate body 14 includes a distal end portion62 (FIG. 4 ) and a proximal end portion 63. The proximal end portion 63of the outer tube 46 is coupled to a rotation knob 66. In some aspectsof the disclosure, the proximal end portion 63 of the outer tube 46includes one or more bores 68 a (FIG. 5 ) and one or more slots 68 b(FIG. 2 ) and the rotation knob 66 includes protrusions 70 that arereceived within the bores 68 a and slots 68 b to axially and rotatablysecure the rotation knob 66 to the outer tube 46. The outer tube 46 andthe rotation knob 66 are supported about the inner shaft 39 (FIG. 5 )and is movable between an advanced position (FIG. 4 ) and a retractedposition (FIGS. 7 and 8 ). In the advanced position, the outer tube 46is positioned about and encompasses the end effector 16. In theretracted position, the outer tube 46 is retracted to a position toexpose a distal portion of the end effector 16 (FIG. 8 ) as described infurther detail below.

The rotation knob 66 defines a through bore 66 a that receives theproximal end portion 63 of the outer tube 46. A biasing member, e.g., acoil spring 74, is positioned within the through bore 66 a of therotation knob 66 between the proximal end portion 63 of the outer tube46 (FIG. 5 ) and the distal hub portion 20 a of the handle body 20 tourge the rotation knob 66 distally about the inner shaft 39 of theelongate body 14. As described above, the outer tube 46 is secured tothe rotation knob 66. Thus, when the rotation knob 66 is urged distallyby the biasing member 74 about the inner shaft 39 of the elongate body14, the outer tube 46 of the elongate body 14 is urged distally aboutthe inner shaft 39 of the elongate body 14 towards its advanced position(FIG. 4 ).

FIG. 2B illustrates the end effector 16 which includes a body 78 havinga central body portion 80, a proximal body portion 82, a distal keyportion 84, and a pair of diametrically opposed flexible arms 90. Inaspects of the disclosure, the flexible arms 90 are formed of springsteel, the body 78 is formed of a polymeric material, and the flexiblearms 90 are secured to the central body portion 80 of the end effector16 using any of a variety of fastening techniques. In one aspect of thedisclosure, the body 78 is molded about the flexible arms 90.

The body 78 of the end effector 16 defines a central through bore 88that receives the actuator rod 44. The central body portion 80 of theend effector 16 is substantially cylindrical and is received in thedistal end portion 62 of the outer tube 46. The central body portion 80has an outer diameter that is substantially equal to the inner diameterof the outer tube 46 of the elongate body 14. The proximal body portion82 of the body 78 of the end effector 16 is cylindrical and is receivedwithin the cylindrical recess 43 (FIG. 2A) of the inner shaft 39 withinthe distal end portion 14 a (FIG. 1 ) of the elongate body 14 to fixedlysecure the end effector 16 to the distal end portion of the inner shaft39. A cylindrical metal bearing 86 is secured about the proximal bodyportion 82 of the body 78 of the end effector 16. It is noted that incertain aspects of the disclosure, the inner shaft 39 of the elongatebody 14 and the end effector 16 are formed from polymeric materials. Themetal bearing 86 provides added strength to the connection between theinner shaft 39 and the end effector 16.

The diametrically opposed flexible arms 90 each includes an inwardlyextending protrusion 92. In aspects of the disclosure, the protrusions92 include tapered distal and proximal surfaces that allow the flexiblearms 90 of the end effector 16 to be deformed about the clip cartridge100 to allow the protrusions 92 of the end effector 16 to be receivedwithin recesses 106 (FIG. 6 ) defined within the clip cartridge 100 asdescribed in further detail below.

FIG. 6 illustrates the clip applier 10 as the clip cartridge 100 issecured to the end effector 16 of the clip applier 100. The clipcartridge 100 includes a body 102 that supports a plurality of clips(not shown). See U.S. Pat. Nos. 5,354,304 and 5,972,003 for a detaileddescription of exemplary aspects of a clip cartridge. The clip cartridge100 includes a proximal body portion including a coupling portion 104.The coupling portion 104 includes recesses 106 that are diametricallyopposed to each other and receive the protrusions 92 on the flexiblearms 90 of the end effector 16 when the clip cartridge 100 is coupled tothe clip applier 10. The coupling portion 104 also defines a transverseslot 108 that receives the distal key portion 84 of the end effector 16to rotatably secure the clip cartridge 100 onto the end effector 16 whenthe clip cartridge 100 is coupled to the clip applier 10 (FIG. 1 ).

FIGS. 7-11 illustrate the clip applier 10 as a clip cartridge 100 iscoupled to the end effector 16 of the clip applier 10. When the clipcartridge 100 is coupled to the end effector 16, the rotation knob 66 ispulled proximally towards the handle assembly 12 in the direction ofarrows “A” in FIG. 7 against the urging of the biasing member 74 toposition the rotation knob 66 about the distal hub portion 20 a of thehandle body 20 of the handle assembly 12. As the rotation knob 66 ismoved in the direction of arrows “A”, the outer tube 46 is moved fromits advanced position (FIG. 4 ) to its retracted position (FIG. 8 ) inthe direction of arrows “B” in FIG. 8 to expose the flexible arms 90 ofthe end effector 16. While maintaining the outer tube 46 of the elongatebody 14 in its retracted position, the coupling portion 104 of the clipcartridge 100 is moved in the direction of arrows “B” in FIG. 8 betweenthe flexible arms 90 of the end effector 16.

When the coupling portion 104 of the clip cartridge 100 engages thetapered distal surface of the flexible arms 90 of the end effector 16,the flexible arms 90 are deformed outwardly in the direction indicatedby arrows “D” in FIG. 9 and pass over the outer surface of the couplingportion 104 of the clip cartridge 100. In aspects of the disclosure, thecoupling portion 104 includes flats 110 (FIG. 6 ) that the flexible arms90 ride along as the clip cartridge 100 is moved in the direction ofarrow “C” in FIGS. 8 and 9 until the protrusions 92 of the flexible arms90 become aligned with the recesses 106 in the coupling portion 104 ofthe clip cartridge 100. When the protrusions 92 of the flexible arms 90become aligned with the recesses 106 in the coupling portion 104 of theclip cartridge 100, the flexible arms 90 snap inwardly in the directionindicated by arrows “E” into the recesses 106 of the clip cartridge 100to secure the clip cartridge 100 onto the end effector 16 of the clipapplier 10. Once the protrusions 92 are received within the recesses106, the rotation knob 66 (FIG. 7 ) can be released to allow the coilspring 74 to move the outer tube 46 in the direction of arrows “F” inFIG. 10 back to its advanced position. In its advanced position, thedistal end portion 62 of the outer tube 46 is positioned about theflexible arms 90 of the end effector 16 to prevent outward movement ofthe flexible arms 90 and retain the protrusions 92 of the flexible arms90 within the recesses 106 of the clip cartridge 100. This preventsseparation of the clip cartridge 100 from the end effector 16 to securethe clip cartridge 100 on the clip applier 10. In aspects of thedisclosure, the outer tube 46 includes inwardly extending tabs 120 thatengage the proximal face 100 a of the clip cartridge 100 when the outertube 46 is in its advanced position.

FIG. 11 illustrates a cross-sectional view of the clip cartridge 100secured to the end effector 16 of the clip applier 10. As illustrated,when the clip cartridge 100 is secured to the end effector 16, thedistal key portion 84 of the end effector 16 is received in thetransverse slot 108 of the clip cartridge 100. Receipt of the distal keyportion 84 of the end effector 16 within the transverse slot 108 of theclip cartridge 100 prevents the clip cartridge 100 from rotating inrelation to the end effector 100.

FIGS. 12 and 13 illustrate an alternative version of an end effector ofthe clip applier 10 which is shown generally as end effector 116. Theend effector 116 is substantially the same as the end effector 16 (FIG.6 ) except that the flexible arms 190 including the protrusions 192 areintegrally and monolithically formed with the body 178 of the endeffector 116. In certain aspects of the disclosure, the end effector 116including the flexible arms 190 is molded from a polymeric material.Alternately, other materials of construction are envisioned includingmetals, ceramics, or the like.

FIGS. 14 and 15 illustrate an alternative handle assembly of the clipapplier 10 shown generally as handle assembly 212. The handle assembly212 is substantially similar to the handle assembly 12 (FIG. 3 ) exceptthat the proximal end portion 254 of the actuation rod 244 includes anoval ring 256 and the engagement member 234 of the actuator handle 218includes a slot 220. The slot 220 receives the oval ring 256 of theactuation rod 244 to prevent the actuation rod 244 from rotating inrelation to the actuator handle 218. The actuator handle 218 andactuation rod 244 function in the same manner as the actuation rod 44and the actuator handle 18 and will not be described in further detailherein.

Persons skilled in the art will understand that the devices and methodsspecifically described herein and illustrated in the accompanyingdrawings are non-limiting exemplary aspects of the disclosure. It isenvisioned that the elements and features illustrated or described inconnection with one exemplary embodiment may be combined with theelements and features of another without departing from the scope of thepresent disclosure. As well, one skilled in the art will appreciatefurther features and advantages of the disclosure based on theabove-described aspects of the disclosure. Accordingly, the disclosureis not to be limited by what has been particularly shown and described,except as indicated by the appended claims.

What is claimed is:
 1. A clip applier comprising: a handle assemblyincluding a handle body and a movable handle, the handle body defining astationary handle and a cavity; an elongate body including an outertube, an inner shaft, and an actuator rod, the inner shaft including aproximal end portion and a distal end portion and defining a channelthat extends from the handle assembly through the outer tube, theproximal end portion of the inner shaft secured to the handle body, theactuator rod including a proximal end portion and a distal end portionand extending from within the cavity of the handle body through thechannel and movable from a retracted position to an advanced position inresponse to actuation of the movable handle, the outer tube including adistal end portion and a proximal end portion, the outer tube positionedabout the inner shaft and movable from a retracted position to anadvanced position; and an end effector fixedly supported on the distalend portion of the inner shaft within the outer tube, the end effectorincluding spaced flexible arms, each of the spaced flexible armsincluding an inwardly extending protrusion, wherein in its advancedposition the outer tube is positioned about the spaced flexible arms ofthe end effector to prevent outward deflection of the flexible arms ofthe end effector and, in its retracted position the outer tube is movedto a position to allow outward deflection of the spaced flexible arms ofthe end effector, the end effector including a distal key portionconfigured to be received within a transverse slot of a clip cartridgeto prevent rotation of the clip cartridge in relation to the endeffector.
 2. The clip applier of claim 1, further including a biasingmember positioned to urge the outer tube towards the advanced position.3. The clip applier of claim 2, further including a rotation knobsecured to the proximal end portion of the outer tube, the rotation knobmovable from an advanced position to a retracted position to move theouter tube from its advanced position to its retracted position.
 4. Theclip applier of claim 3, wherein the biasing member includes a coilspring that is received about the proximal end portion of the innershaft within the rotation knob.
 5. The clip applier of claim 1, whereinthe end effector includes a body formed of a polymeric material and thespaced flexible arms are formed of spring steel and are secured to thebody of the end effector.
 6. The clip applier of claim 5, wherein thebody of the end effector is molded about the spaced flexible arms. 7.The clip applier of claim 1, wherein the end effector includes a bodythat is monolithically formed with the spaced flexible arms of the endeffector.
 8. The clip applier of claim 1, wherein the movable handleincludes an engagement member positioned within the cavity of the handlebody and movable between retracted and advanced positions to move theactuator rod between its advanced and retracted positions.
 9. The clipapplier of claim 8, wherein the engagement member includes an engagementsurface and the proximal end portion of the actuator rod includes anabutment member, the engagement surface engaged with the abutment membersuch that actuation of the movable handle causes movement of theactuator rod from its retracted position to its advanced position. 10.The clip applier of claim 9, wherein the abutment member is disc-shaped,and the engagement surface is curved.
 11. The clip applier of claim 9,wherein the engagement member defines a slot and the abutment memberincludes an oval ring that is received within the slot.
 12. The clipapplier of claim 1, wherein the distal end portion of the inner shaft ofthe elongate body defines a cylindrical cavity and the end effectorincludes a cylindrical body portion that is received within thecylindrical cavity to secure the end effector to the distal end portionof the inner shaft.
 13. The clip applier of claim 12, further includinga metal bearing positioned about the proximal body portion of the endeffector within the cylindrical cavity of the inner shaft of theelongate body.
 14. The clip applier of claim 8, further including abiasing member positioned about the proximal end portion of the actuatorrod to urge the actuator rod towards its retracted position.
 15. A clipapplier comprising: a handle assembly including a handle body and amovable handle, the handle body defining a stationary handle and acavity; an elongate body including an outer tube and an inner shaft, theinner shaft including a proximal end portion and a distal end portionand defining a channel that extends from the handle assembly through theouter tube, the proximal end portion of the inner shaft secured to thehandle body, the outer tube including a distal end portion and aproximal end portion, the outer tube positioned about the inner shaftand movable from a retracted position to an advanced position; a clipcartridge having a proximal surface defining a transverse slot; and anend effector fixedly supported on the distal end portion of the innershaft within the outer tube, the end effector including spaced flexiblearms, each of the spaced flexible arms including an inwardly extendingprotrusion, wherein in its advanced position the outer tube ispositioned about the spaced flexible arms of the end effector to preventoutward deflection of the flexible arms of the end effector and, in itsretracted position the outer tube is moved to a position to allowoutward deflection of the spaced flexible arms of the end effector, theend effector including a distal key portion configured to be receivedwithin the transverse slot of the clip cartridge to prevent rotation ofthe clip cartridge in relation to the end effector.
 16. The clip applierof claim 15, further including a biasing member positioned to urge theouter tube towards the advanced position.
 17. The clip applier of claim16, further including a rotation knob secured to the proximal endportion of the outer tube, the rotation knob movable from an advancedposition to a retracted position to move the outer tube from itsadvanced position to its retracted position.
 18. The clip applier ofclaim 15, wherein the end effector includes a body formed of a polymericmaterial and the spaced flexible arms are formed of spring steel and aresecured to the body of the end effector.
 19. The clip applier of claim15, wherein the end effector includes a body that is monolithicallyformed with the spaced flexible arms of the end effector.
 20. A clipapplier comprising: a handle assembly including a handle body and amovable handle, the handle body defining a stationary handle and acavity; an elongate body including an outer tube, an inner shaft, and anactuator rod, the inner shaft including a proximal end portion and adistal end portion and defining a channel that extends from the handleassembly through the outer tube, the proximal end portion of the innershaft secured to the handle body, the actuator rod including a proximalend portion and a distal end portion and extending from within thecavity of the handle body through the channel and movable from aretracted position to an advanced position in response to actuation ofthe movable handle, the outer tube including a distal end portion and aproximal end portion, the outer tube positioned about the inner shaftand movable from a retracted position to an advanced position; a clipcartridge having a proximal surface defining a transverse slot; an endeffector fixedly supported on the distal end portion of the inner shaftwithin the outer tube, the end effector including spaced flexible arms,each of the spaced flexible arms including an inwardly extendingprotrusion, wherein in its advanced position the outer tube ispositioned about the spaced flexible arms of the end effector to preventoutward deflection of the flexible arms of the end effector and, in itsretracted position the outer tube is moved to a position to allowoutward deflection of the spaced flexible arms of the end effector, theend effector including a distal key portion configured to be receivedwithin the transverse slot of the clip cartridge to prevent rotation ofthe clip cartridge in relation to the end effector; a first biasingmember positioned to urge the outer tube towards the advanced position;and a second biasing member positioned about the proximal end portion ofthe actuator rod to urge the actuator rod to its retracted position.